The development of modern endoscopic devices has enabled surgeons to perform numerous surgical procedures within body cavities, under endoscopic visualization, without the need for large operative incisions. Such endoscopic procedures are typically performed by inserting an endoscope and the necessary surgical instrumentation through one or more small body openings or minimal access incisions of 1 cm or less.
Examples of endoscopic surgical procedures which have heretofore been performed through small body openings or minimal access incisions include intra-abdominal laparoscopic procedures such as, but not limited to, cholecystectomies, appendectomies, nephrectomies, tumor resections, fallopian tube ligations, etc.
Such laparoscopic surgical procedures are typically performed under general anesthesia. After the patient has been anesthetized, an inflation needle is initially inserted into the abdomen and carbon dioxide is passed through such inflation needle into the peritoneum to create a distended pneumoperitoneum. The peritoneum is typically insufflated to a pressure of 14-18 mm Hg. Once the distended pneumoperitoneum has been established, a primary trocar is inserted into the peritoneum through a small periumbilical incision or puncture cite. Additional tubular trocars may be inserted into the peritoneum at other sites on the abdominal midline or lateral to the midline.
Each trocar inserted into the abdomen is typically provided with a sealing or valving apparatus. Such sealing or valving apparatus operates to substantially prevent leakage from the pneumoperitoneum when the trocar is inserted into the pneumoperitoneum.
The laparoscopy trocars employed in typical laparoscopic applications range in diameter from approximately 5 mm-11 mm. Each instrument, cannula or scope to be inserted through a laparoscopy trocar is necessarily smaller in size than the inner diameter of the trocar through which it is to be inserted.
A puncturing stylet having a sharp tip is initially insertable through the lumen of the trocar such that the puncturing tip of the stylet initially extends slightly beyond the distal end of the trocar. With the puncturing stylet so positioned, the trocar is initially grasped by the operator and inserted into the peritoneum. Upon entry into the peritoneum, a specific change in resistance or a "snap" is felt by the operator, indicating that the puncturing tip of the stylet has penetrated the peritoneal membrane. After the trocar has been so inserted, the puncturing stylet is withdrawn and removed. The tubular trocar may then be utilized as an access route or passageway for inserting and removing various surgical instruments, scopes, cannulae and/or other apparatus into the peritoneal cavity
Examples of surgical instruments which are insertable through the typical laparoscopy trocar include forceps, clamps, scissors, probes, flexible or rigid scopes and cutting instruments. Additionally, automated or powered devices such as electrocauteries and/or laser cutting/cauterization devices may also be passed into the peritoneum through such laparoscopy trocars for use in cutting and/or cauterizing tissues during laparoscopic surgical procedures.
Examples of other types of apparatus which are sometimes inserted through laparoscopic trocars include elongate devices for introducing and retrieving tissue containment sacs or bags, such as that described in U. S. Pat. No. 5,037,379 entitled SURGICAL TISSUE BAG AND METHOD FOR PERCUTANEOUSLY DEBULKING TISSUE, and that described in application Ser. No. 07/779,443 entitled METHOD AND SYSTEM FOR ENCLOSING, MANIPULATING, DEBULKING AND REMOVING TISSUE THROUGH MINIMAL ACCESS INCISIONS, of which this application is a continuation-in-part. Also, in some procedures, it is necessary to pass one or more devices for grinding, mulching, cutting, morcellizing or debulking tissue, stones or other matter. Such a device is disclosed in U.S. patent application Ser. No. 07/639,494 entitled METHOD AND DEVICE FOR INTRACORPOREAL LIQUIDIZATION OF TISSUE AND/OR INTRACORPOREAL FRAGMENTATION OF CALCULI DURING ENDOSCOPIC SURGICAL PROCEDURES, of which this application is a continuation-in-part.
These laparoscopy trocars employed in most laparoscopy applications are 5-15 cm penetrating length, measured from the surface of the skin.
In certain applications wherein an organ, sac, or other container is to be removed from a body cavity through a small (e.g. 1 cm) laparoscopy incision, such removal may be complicated or prevented if the matter contained within the organ, or the organ itself is too large or too bulky to pass through the small (e.g. 1 cm) incision. In such cases, it may be desirable to (a) use the first laparoscopy trocar to introduce an organ holding bag or sac into the abdominal cavity; (b) position the organ adjacent to or inside the sac such that the contents of the organ may be extracted from the organ and placed into the sac; (c) operatively incise the organ and place the contents of the organ into the sac; (d) externalize the first laparoscopy trocar, the sao inserting introducer, and the organ containing sac; (e) introduce a second, shorter (e.g. 3-8 cm in length) trocar into the organ-containing sac; (f) insert one or more instruments into the holding bag or sac through the second trocar to attempt to crush or remove the offending material therefrom; and, if unsuccessful, (g) remove the second shorter trocar and insert an elongated instrument into the organ holding bag to grind, pulverize, debulk, morcellize, or otherwise treat the material contained therein to facilitate removal of such material and subsequent passage of the holding bag through the small (e.g. 1 cm) incision. Thus, in such applications, it may be necessary to separately utilize one (1) long trocar, one (1) holding bag and insertion device, one (1) short trocar and one (1) elongate cutting instrument to effect final removal of the organ sao or container. Accordingly, there exists a need in the art for an improved laparoscopy trocar device having a single upper valving member with multiple interchangeable lower trocar and/or debulking aspiration portions attachable to the single upper valving assembly. Additionally, there exists a need for a complete laparoscopy system whereby the device of the foregoing character may be intermittently utilized in connection with (a) a peritoneum penetrating stylet; (b) an intraperitoneal containment sac and insertion device; (c) various forceps and other standard hand instruments; and (d) a pneumatic, electric or mechanical debulking/aspiration device.